I Believe…

our-deepest-fear-1

This is the famous quote from author, Marianne Williamson.

I read this for the first time printed in The Oregonian on a random page apropos of nothing – it wasn’t part of a larger article or a highlighted quote. Someone, for some reason, spent what would have been a bit of money back in the day, to have this printed up in the paper for me to find. It was misattributed to Nelson Mandela (which, apparently happens ALL the time!) And for some inexplicable reason, I felt compelled to cut this 3×6 inch section out of the paper and place it prominently on the front of my refrigerator.

That was about 20 years ago.

It has a few grease stains on it, and there’s a strip of tape along the top. It has yellowed and bears the mark of time all along it’s tattered edges. Yet it remains (more or less) intact. This quote is what I look to whenever I’m needing to be reminded that all of us – every single one of us – has the capacity for darkness.

But it is our light that holds true power. And that light is not just in some of us.

It’s in everyone.

May our collective light shine.

 

World Breastfeeding Week – But Is It Always Happy?

Bottle Baby

“It’s really hard sometimes. I’m frantically trying to mix the bottle and he’s really hungry and upset and I could comfort him so much more quickly if I could just breastfeed him. I wish I knew why they didn’t do what they were supposed to. Why didn’t you work?!” She looked down at her chest and aimed this last question directly at her breasts as she let out a heavy sigh. When she looked up I saw her forced smile, but I could also see the pain in her eyes.

I reassured her, “Your baby is gorgeous and thriving, so you must be giving him exactly what he needs!” And then the conversation shifted to how bottle-feeding was going. I was happy to hear that they’d found a formula that the baby was tolerating well and that Dad had jumped into help with feeding his newborn son – a happy and alert four-month old, curious about the world around him.

The assumption is, that if a woman has the equipment and a baby has the breathe-suck-swallow-reflex, all you need to do is put the two together, and – Voilá! Breastfeeding happens, no problem! And when it does work out that way, it’s fantastic! But it doesn’t always work out that way. In fact, I think a lot of women would place breastfeeding challenges at the top of their list of unexpected outcomes – but only after they’ve had their baby.

If I taught breastfeeding – which I don’t, I’m not trained to do so – my classes would probably focus on the challenges that a woman might face. (Remember me? I don’t call myself “The REP” for nothing!) I recognize the valid concern that if all we talk about are the challenges of breastfeeding, that this might discourage women from attempting breastfeeding in the first place. I get that. But it’s all in the delivery of the information!

There’s a balance to strike between “Here are some challenges that you might face when you’re breastfeeding” and “Wow! Breastfeeding is going to be waaaaaay harder than you think!” I continue to hear from so many women that they wish they’d known more in those early days and weeks about how challenging breastfeeding might actually be for them.

Now, I’m lucky enough to have friends who are excellent breastfeeding educators and lactation specialists and I know first-hand that they do talk about breastfeeding challenges – both in the classroom and one-on-one. Maybe this information just isn’t able to fully sink into the minds of these pregnant women who are still fixated on how they’re going to get the baby out.

In any case, women share with me how their feelings of being unprepared lead them to feeling “broken” and then guilty at not being able to do what is best for their baby (“Breast is Best!” after all. Yes, they know… they hear it all the time.) It literally breaks my heart.

In Portland, Oregon if breastfeeding goes well for you, than this can be a wonderful city to live in. We’ve got Baby Friendly hospitals, amazing IBCLC trained lactation specialists, great initiation rates, some impressive longevity rates, and many people feel more comfortable breastfeeding in public here than in other parts of the country because they see it all around them and know that what they’re doing is largely supported.

But, if for any reason, breastfeeding does not go well for you, than living in Portland, Oregon can be really tough. There’s a lot of judgement about bottle-feeding in this town. Maybe this is also true where you live?

I’m not trying to promote bottle-feeding over breastfeeding. I breastfed all four of my kiddos until they were close to two years old. I promote breastfeeding all over the place, personally as well as professionally. I am a breastfeeding advocate.

AND I’m also a new parent advocate.

I want to support these new parents – even more so if they’ve had to make a challenging decision while feeling vulnerable and still trying to find their way in their new roles as parents.

I want to provide positive attention to those women who’re truly unable to breastfeed or who’ve made the decision to bottle-feed their babies for a number of different and valid reasons. Oftentimes, this can be the most difficult decision they’ve had to make as a new Momma. Most of the women that I know personally who’ve had to switch to any amount of supplemental feeding for their babies have only done so after weeks and months of trying to get breastfeeding to work. The amount of effort they have exerted is nothing short of Herculean.

So, how can we better support Mommas who’ve had to make a decision that goes against the way want to feed their baby, when they’re confronted with the reality that breastfeeding is no longer an option?

I’d just like to acknowledge that for some women, “Happy World Breastfeeding Week!” might not be that happy. Those of us who’ve been able to breastfeed can be grateful that breastfeeding was not that challenging for us, or if we did have challenges we were able to move past them and continue to breastfeed. But maybe can we also try to be more supportive, truly supportive, of the Mommas who’ve had to make other, different, hard choices around the issue of breastfeeding?

Instead of judgement, let’s offer each other a soft place to land in this challenging and trying world that is new parenting. Be gentle with one another. Be gentle with ourselves. We’re all doing the very best we can for our babies, and they’re thriving because of our tender love and care. This is hard work, and we need all the support we can get.

What was your breastfeeding relationship like with your baby(ies)? Easy-peasy, challenging-but-doable, or it-just-didn’t-happen? How do you feel about that? Were you able to find support? Where? Please share your comments with me. I appreciate them and YOU so much!

34 = A Spring Chicken, But 35 = An Old Bird?! I Cry Fowl!

Chickens

I was busy all weekend doing what I love: teaching expectant families all about how to get a baby out (Saturday – Express Class) and where to go when the baby is actually coming out (Sunday – Maternity Tour). It was a gorgeous, sunny, not-too-hot weekend and I was stuck inside both days catching glimpses of the sun when and where I could. AND I WASN’T EVEN MAD.

I mean, I saw how nice the weather was the night before, and I may have even mumbled, “Ohhhhhh, I don’t want to go to work tomorrow!” before going to bed, but some sort of alchemic transformation happens when a class or tour begins. And then I know I’m exactly where I need to be, doing exactly what I’m supposed to be doing. I’m not sure if anyone else can truly understand this, unless they too, are lucky enough to have a job that they love.

At the end of class on Saturday, a healthy and fit-looking young couple came up to me to ask a question about their particular situation. “I’m 35 years old,” she began and I already knew where this was going… “And yours is considered a “Geriatric Pregnancy,” am I right?” She kind of laughed and then said, “Yep – ‘Advanced Maternal Age!’ And my provider wants to induce me at 39 weeks. I just wanted to know what my chances are of having an induction that goes okay. One that won’t end with a Cesarean.”

Now, I don’t know the particulars of this woman’s health history, and I’m not a medical provider, so I’m not going to debate this plan of action. But I could tell that she wanted to know if this induction at 39 weeks would be considered “medically necessary.” Again, without knowing her personal health history, I’m not going there with her.

Here’s what I told her instead: “If your provider had a Momma over the age of 35 who had a “negative outcome” during their birth, it might change how they practice from that point forward. But many providers are only looking at the relative risk of increased complications that can happen to women over the age of 35. Is your provider looking at your absolute risk?”

This is not something that many providers consider. They read a study that says a woman’s risk of stillbirth increases after the age of 35, but their focus remains solely on the age of the woman in their care, and this can translate into only discussing her relative risk. If they were looking at the woman’s age as just one of several other risk factors that might contribute to or lessen their overall risk, this would mean that they were considering the absolute risk. Too many women don’t even know to ask about relative vs absolute risk, and too many providers are not forthcoming with this information.

Pregnant women and their partners should be able to determine their individual, personal absolute risk of complications and what those complications are if they wait to deliver spontaneously at term, as opposed to being encouraged to deliver early via induction at 39 weeks, because their is a relative risk of increased stillbirth for women over the age of 35.

The risk is real, it’s true – but there are many, many other factors to consider in assessing an individual woman’s absolute risk of any complications, not just the risks associated with “Advanced Maternal Age.”

I might be a little bit touchy on this subject, if I’m being completely honest. I mean, I didn’t get married until I was 28. I had my first child at 31. Baby #2 came along when I was 33 1/2. My third was born when I was (gasp!) 37, and the last one came along at the ripe old age of 41.

And while it is true that my relative risk of stillbirth climbed with my age, my absolute risk as a multipara with Baby #4 was probably lower than that of a primipara at a much younger age. Part of that lowered absolute risk has to do with my proven record of straight-forward, healthy pregnancies and deliveries. And part can be attributed to the fact that I was in much better health at 41 than I’d been when I began this whole baby-making enterprise ten years earlier!

The language – older mother, mature, advanced maternal age, elderly, and my personal favorite, geriatric pregnancy – coupled with the assumption that a woman is automatically high-risk because of her age really bothers me! The power of words cannot be understated. And when a woman is told that she is high-risk, strictly because she is over the age of 35, with no other known risk factors, this absolutely affects how she experiences her pregnancy and can have negative implications for her birth! 

So with all of this as a backdrop, I suggested that this Momma do some research and that she might find some good information online. Rarely, do I send anyone to the inter webs for information. First of all – there’s just so damn much of it! How are you supposed to sift through all of the mountains of information that now exist in the world on the subjects of pregnancy, birth and parenting? But in addition to that, there’s just so much out there not evidence-based and that’s really scary!

That’s why I was so excited when I “met” Rebecca Dekker a few years back as she was just starting up her website, Evidence Based Birth. Rebecca wanted to create a resource for expectant families (and professionals!) that would review the latest research on a particular topic in obstetrics and translate the findings into something that someone who wasn’t a clinician or a researcher could actually understand.

She takes her time with each article and reviews everything, making sure to use “good” studies – meaning studies that are unbiased, that used the proper technique, assessment and validation tools, and that have statistically significant results. After she’s written her article, she submits it to her advisory Board to insure that the information that goes “live” on the website is exactly what she claims it to be: evidence-based. I know that if I send any of my families to her website, I can feel comfortable that the information they’ll find there is something I can trust.

How crazy is it that I took a look at the EBB website this afternoon and did a search for “Advanced Maternal Age” and found out that Rebecca was doing a free webinar on that exact topic in exactly three minutes! I know, right? Cue up the woo-woo music!

I quickly registered for the webinar and was happy to hear that the discussion I had with the Momma from my class about relative risk vs absolute risk was exactly what Rebecca would be covering in both the webinar and the written materials that accompany it on the website. I really hope that the Momma from class took me up on my suggestion and checked it out.

After doing this important work of researching, I encouraged her to have some more dialogue with her provider about her particular situation. In the end, she might come to the conclusion that an induction at 39 weeks is reasonable for her and her pregnancy. Or, she might not. But what is most important, is that she will be making a decision with her provider based on full information.

In this day and age, I think we should be encouraging women to know what their absolute risk vs their relative risk is so they can make truly informed decisions for themselves about their pregnancies, their births, and their babies.

In the meantime – can we please come up with another way of describing a woman who happens to be having a baby at the age of 35 or beyond? The terms we’re currently using are demoralizing. And I should know!

Thankfully, it’s not all bad. Based on this article, us “Geriatric Mommas” will have the last laugh: “Women who had their last child after 33 were twice as likely to live to 95 or older, compared with those who had their last child by 29.”

I’m not a math whiz by any account, but if my calculations are correct, this means I will live to be at least 125 seeing as I had my last baby eight years after the magical cut-off  of “33” as quoted in this article.

But before I get my hopes up, I think I’d like to know what my absolute advantage is, not just the relative advantage based on my age.

Know what I mean?

Hopelessly Devoted to You…

Devoted

de·vot·ed
/dəˈvōdəd/

adjective
adjective: devoted
1. very loving or loyal.
“he was a devoted husband”
synonyms: loyal, faithful, true, staunch, steadfast, constant, committed, dedicated, devout; fond, loving, affectionate, caring, admiring
“a devoted follower of the writer”
2. given over to the display, study, or discussion of.
“there is a museum devoted to her work”

I love this dictionary entry for “devoted.” I would consider myself a very devoted Momma, partner, friend, daughter, sister, employee and Childbirth Educator. When I’ve found someone or something that I believe in, then it’s deserving of my full devotion. I resonate with both of these definitions, because I don’t think it’s enough to say that you’re “very loving and loyal” to a person or an idea. I think you need to show that devotion through action, which is where, “given over to the display, study or discussion of” comes in.

But being devoted to someone or something might mean saying or taking action that’s not very popular. Sometimes, being devoted means standing up for your own truth – even when others, maybe especially when others, try to tell you your truth is wrong or has no merit. Being devoted doesn’t mean that you always agree. Being devoted to a person or an idea, means you have to be the mirror at times. In wanting this person or idea to reach full potential, you have to be willing to shine a light in the darkness. Being devoted is both thrilling and frightening at the same time. But it’s not usually easy to be on the giving or receiving end of real devotion.

I can remember a few times in my marriage, where my incredibly devoted husband told me what I needed to hear. Let’s be very clear: it wasn’t what I wanted to hear, but it was exactly what I needed to hear. And I’m sure he can tell you some stories about my job as his personal mirror: “This is what I see. This is not who I know your best self to be.” Not easy discussions to have, but they can be game-changers, in my opinion.

When it comes to my work with expectant families I am devoted to the overall well-being of new Mommas, partners and their babies on their transformative journey of becoming a family.

But sometimes, that devotion can look a little bit more like “tough-love.”

I’m very devoted to the idea that women have positive and empowering birth experiences because I feel like this moment in a woman’s life can truly be transformative. It can set the stage for how well she moves into her role of Momma. It can either positively or negatively affect the couple’s relationship right from the very start. She can end up parenting from a place of inner strength, wisdom and confidence – or spend her entire parenting journey second-guessing every move. Her birth experience might only be a day in her life, but it can affect the rest of her life.

Wow – that’s big stuff.

And now for the tough-love talk. (Please remember that this is coming from a very loving and loyal place.)

Women need to start taking more personal responsibility for their births.

There are some providers, nurses and hospital policies that can get in the way of a woman’s positive and empowering birth experience. And there are plenty of other birth advocates decrying this very issue. But that’s not the whole issue. Women need to recognize their role in all of this. They need to take more personal responsibility for their birth experiences because if they don’t, birthing women, their partners and the families they’re trying to create together end up paying the price.

Women giving birth today, are doing so in a climate where information is everywhere and available all the time. Even though “Dr. Google” is not a great resource, it’s who they most often turn to for information – much of it biased, out-dated, and not evidence based.

Our maternity care system has become “us against them” when it comes to birth. I’m not sure it’s even possible to have a positive and empowering birth experience if you believe that having a hospital birth is going to suck. But if you really do feel this way, than take some personal responsibility for yourself and make different choices about where and with whom you’ll be giving birth. Your reaction might be, “It’s not that easy.” I know it’s not easy. I’m not saying that it is. What I’m saying is that it’s vital to own your role in the birth experience – even when it’s not easy.

When I was pregnant with my second baby, I had to make some big decisions. My beloved provider had moved out of town and our insurance had changed. So, I was going to have a choose a new provider and place to give birth.

Instead of doing my own research, I listened to a colleague and chose a midwife at a hospital that didn’t have the best reputation in town: too big and impersonal. Red flag #1 The clinic was pretty far away from where we lived, which meant my toddler and I had to deal with 40 minutes of driving for an appointment that lasted only 10 minutes. I hated it. Red flag #2 The hospital tour guide focused more on the big-screen TV than answering my questions about birth balls and squatting bars. Red flag #3 My midwife was part of a group practice, so it was not guaranteed that I would have her for my birth. Red flag #4 Now, none of these might pop up on your list as red flags – but they were on mine and I chose to ignore all of them. I knew, at several points along my pregnancy journey, that this was not the right choice for me, but I refused to take personal responsibility for this. And although my birth was quick and easy, my overall birth experience was very negative.

I hadn’t done my due diligence to make the best decisions for myself when and where I could. And it was this piece that I struggled with most in my early postpartum days with my newborn. I look back and realize my negative feelings around that birth experience had nothing to do with the birth outcome. It had everything to do with how I had dishonored myself and failed to make the best (although not easy) decisions I could to set myself up for the best experience possible.

Writing a Birth Plan is not enough. Having good intentions is not enough. Hiring a doula is not enough. You need to understand just how much work is involved in making this birth experience positive and empowering for yourself. No one will be making that happen for you. You need to make it happen. And that means getting real with yourself before you ever put pen to paper to capture your birth preferences.

Are you making choices that resonate with you? Don’t concern yourself with what your sister, BFF or members of your book club would choose. What do you want? Make some decisions for yourself. But don’t stop there! Get some quality, unbiased, evidence-based information that supports these decisions as being right for you. And then own those decisions – at least until you go into labor.

Once labor begins, you have to be prepared to make some decisions in real-time, as birth unfolds. Birth is too big to be planned out on an 8 1/2 x 11 piece of paper! And that scale you used to weigh benefits and risks in the classroom doesn’t get to come into labor and delivery with you. You get a brand new scale that you’ll have to use to weigh the benefits and risks all over again to make the most informed decision you can – while you’re in labor.

You must be a full participant in this birth from the very beginning all the way through to the end in order to feel that transformative strength and empowerment. My own personal experience, coupled with 20 years of working with thousands of couples, allows me to make this statement from a place of confidence: Feeling empowered and positive about your birth experience is less connected to how your baby is born, and more directly linked to how you feel as your baby is being born.

When you give birth from a place of confidence that you did everything you could in the moment to honor yourself and your process, it’s hard to feel anything but empowered. There are moments throughout your pregnancy and birth where you’re called to stand up and make a decision that might not be easy, that might not be popular, that might not even be what you wanted. But in honoring yourself in this way, you can claim full participation and own your birth experience.

When you do this, you show devotion to yourself, your partner, your baby, your family – and this is where it all begins.

What are you devoted to? Does this resonate with you? Are you still able to feel my deep devotion to you (despite my tough love)? I really do only want the best possible experience for you. And I can’t use this title for the post without giving you this link to the ever wonderful ONJ singing her heart out – enjoy, you’ll be singing it all weekend.

This was part of an exercise from The Writing Den, where we were asked to define what we are devoted to. Bringing more personal responsibility into the birthing experience is one of those things I’m devoted to. If you’d like to find out what your true devotion is, come join this group of committed individuals answering the call. It’s an inspiring place to be!

I’m a Literary Mama!

LMToday is the day!

I received the official news from the editors at Literary Mama that my essay I submitted to them in late Summer, which eventually went through six revisions, has gone live!

I’m so excited for this “origin story” to be out there in print. It tells how I came to be a writer, a title which I am finally beginning to own. The process of working with the editors at LM was wonderful for me. They were patient, encouraging and I could feel with each back and forth that they were really wanting my piece to be the best version possible. I think we achieved that together: my words + their editing prowess.

If you’re interested in great writing by women, who also happen to be mothers, please do yourself a favor and head over here to read some amazing stuff.

And while you’re there, read my essay and join the revolution, won’t you?

Thanks so much for your continued support of me and my writing. It means everything to me!

PS – If you have a story to tell, or a personal revolution you’re wanting to start – but need guidance just how to do this in an authentic way, I highly recommend Jeffrey Davis and his Tracking Wonder team of professionals. Jeffrey is leading this group of amazing individuals who are committed to doing business as unusual, and unlocking your best potential.

Bridge-Building Activism – Is That a Thing?

Arch

Sometimes I wonder where my place is in the world of birth. There are so many people who have come before and paved the way for where we are today. Some would argue we have so much farther to go, and they’re right.

There are a lot of people who work in my field who are activists – writing and speaking and fighting for change. I am grateful for them, their words and their actions. But sometimes I struggle with not having that particular fire in my belly. When I started seriously working on my book, one of my lovely mentors, Heidi, asked me straight up if I considered myself an activist – and I could almost feel myself physically recoil from that word. An activist? Me?! No, no no…

While it’s true that I don’t shy away from conflict (as my Mom told me once – what does t mean?), what I really love is conflict resolution. That moment when two people sitting across from one another with an ocean of division between them inch ever slowly toward one another, noticing just how similar “the other” actually is to themselves. When these two can cross that chasm because of a bridge that I have helped to build, that’s a straight shot to my dopamine reward center.

When Heidi suggested that I was an activist, the word didn’t seem to jibe with the picture I had of myself. Until, she suggested that I was an activist for my families. Not the whole world of birth, but the people that I work with directly within that world of birth. Yes! This, I could agree to wholeheartedly.

I am an activist for my families.

But my way of activism is to encourage dialogue, to create bridges, to seek out similarities, and downplay differences – to create community so that we can all work toward the same goal: birth that is family-centered and recognizes the powerful transformation that is possible when this is held at the core of the birth experience.

It makes me think of the moment of birth that I’ve been lucky to witness before, in my own births, in births that I’ve been fortunate enough to attend, and in the retelling of  transformative birth stories – when everyone in the room was acutely aware something extraordinary had just happened. 

Because it does happen in every single birth – but how often is this recognized?

It’s challenging for that awareness to occur if bridges of understanding and trust haven’t been built. Bridges between the couple, and then with other birth support members, their L&D nurses and their provider must be in place for that moment to happen. I’d like to think that the work I do in my classes and through my writing is not to actually build those bridges, but maybe to act more like the arch of those bridges. I’d like to think that I’m providing my families with the support that they need in order to build their own bridges. So that when that moment of transformation happens they can experience it fully. And anyone else lucky enough to act as witness can be transformed, too.

If this makes me an activist, then I guess that’s what I am. In my own way.

Do you consider yourself an activist for birth? In what way? Can bridge-building and activism go together? I’d love to hear your thoughts, please leave me a comment.